Covid-19 - Vulnerable Highest Risk Patients (Shielding)

People in the Clinically Extremely Vulnerable Group who have been Shielding

On 22nd June 2020, the government announced details on easing for those patients on the shielding list and updated the guidance for this group.

From Monday 6 July, those shielding from coronavirus can gather in groups of up to 6 people outdoors and form a ‘support bubble’ with another household

The Government shielding support package will remain in place until the end of July when people will no longer be advised to shield.

From Saturday 1 August, the guidance will then be relaxed so clinically extremely vulnerable people will no longer be advised to shield, but support will remain available from NHS volunteers and local councils. People will retain their priority for supermarket delivery slots, and still be able to access help with shopping, medication, phone calls and transport to medical appointments. Also from 1st August, those who need to work and cannot do so from home will be able to return to work as long as their workplace is COVID-19 secure, adhering to the guidance available.

NHSE advised that they will continue to maintain the Shielded Patient List allowing them to continue to provide targeted advice and support to this cohort and to change advice and support if the incidence was to rise significantly. 

Children

Further guidance was published in 8th July confirming that the majority currently considered extremely vulnerable to Covid-19 would be able to be removed from the shielded patient list.  The guidance can be viewed here .

The Royal College of Paediatrics and Child Health

Covid-19 – shielding advice for children and young people

Summary

The RCPH has updated its advice for clinicians on which paediatric patient groups should be advised to 'shield' during the COVID-19 outbreak, to protect those at very high risk of severe illness from coming into contact with the virus. It also provides frequently asked questions on how 'shielding' applies to children and families. We would recommend that you refer to the detailed guidance for comprehensive advice, however, the following provides a summary of some of the key points.

In updating their advice, the RCPH has conducted a review of the evidence which has indicated that not all those children and young people who are currently advised to shield need to continue to do so. The majority of children with conditions including asthma, diabetes, epilepsy, and kidney disease do not need to continue to shield and can, for example, return to school as they reopen. This includes many children with conditions such as cerebral palsy and scoliosis, for whom the benefits of school - in terms of access to therapies and developmental support - far outweigh the risk of infection.

In principle:

• Children and young people who are cared for just in primary care are very unlikely to need to continue to shield.
• A small group of children who are ‘clinically extremely vulnerable’ due to their pre-existing condition will need to continue to shield.
• A further larger group of children exists who due to their underlying condition may need to shield and the decision to continue to shield would normally result from a discussion between the clinician, the child and their family

In the document, conditions are divided into two groups, as follows:

• Group A lists conditions that require continued shielding. A child with a condition in Group A should be advised to shield.
• Group B lists conditions that require discussion between the clinician and the child and their family/carer to establish whether on a case by case basis continued shielding is required. A child in Group B should have a discussion with their clinical team to establish whether on balance of risks they should be advised to shield. Not all children and young people with conditions listed in Group B will need to shield. If following a discussion, they are advised not to shield, the child should maintain stringent social distancing.

Group A includes:

• Immunodeficiency and immunosuppression
• Oncology

Group B includes:

Conditions listed in the categories below will require a case-by-case discussion to decide whether, on the balance of risks, a child should be advised to continue shield. Not all children and young people in the categories listed below will need to shield.

A decision to shield will depend on the severity of the condition and knowledge that the secondary and tertiary care clinical teams have of the particular circumstances of the child. If following a discussion, a child is advised not to shield, they should maintain stringent social distancing.

• Cardiology
• Dermatology
• Haematology
• Immunodeficiency
• Neonatal
• Neurology
• Paediatric Gastroenterology, Hepatology & Nutrition
• Respiratory
• Renal
• Rheumatology / Paediatric ophthalmology

Children who are shielded should still attend hospital for essential treatment as recommended by their clinical teams, following risk assessment.

The RCPH advice reflects the current understanding of the risks associated with COVID-19 infection.  Their  advice will continue to be updated and revised more is understood about the impact of COVID-19 infection on the health of children and young people with comorbidities.  It is therefore important to refer to the full guidance at https://www.rcpch.ac.uk/resources/covid-19-shielding-guidance-children-young-people#introduction .